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Reflections on the 1976 Swine Flu Vaccination Program
In 1976, 2 recruits at Fort Dix, New Jersey, had an influenzalike illness. Isolates of virus taken from them included A/New Jersey/76 (Hsw1n1), a strain similar to the virus believed at the time to be the cause of the 1918 pandemic, commonly known as swine flu. Serologic studies at Fort Dix suggested that >200 soldiers had been infected and that person-to-person transmission had occurred.
Lessons learned from the 1976 National Influenza Immunization Program (NIIP).
1. Expect the unexpected: it will always happen. Some examples:
• Children did not respond to the initial formulation of vaccine.
• Liability for untoward events after immunization became a major issue.
• Deaths occurred in Pittsburgh that were coincidental with but unrelated to the vaccines (8).
• Cases of a new and unrelated disease, Legionnaires disease, appeared (9).
• "Excess" cases of Guillain-Barré syndrome appeared among recipients of vaccines (10).
• Erroneous laboratory reports of viral isolates or serologic conversions occurred in Washington, DC, Boston, Virginia, and Taiwan.
• The pandemic failed to appear.
2. Surveillance for influenza disease worked well. This was plain, "old-fashioned" surveillance without computers. A new strain of influenza was identified within weeks of the first recognized outbreak of illness.
3. Interagency cooperation works without formal agreements. The state health departments, military, National Institutes of Health, US Food and Drug Administration, and Center for Disease Control all worked together in a cooperative and mutually beneficial manner.
4. Surveillance for untoward events demonstrated that only when large numbers of people are exposed to a vaccine or drug are adverse reactions identified (Guillain-Barré syndrome with influenza vaccines; paralysis with the Cutter poliovirus vaccine in 1955).
5. Health legislation can and should be developed on the basis of the epidemiologic picture.
6. Media and public awareness can be a major obstacle to implementing a large, innovative program responding to risks that are difficult, if not impossible, to quantitate.
• Creating a program as a presidential initiative makes modifying or stopping the program more difficult.
• Explanations should be communicated by those who can give authoritative scientific information.
• Periodic press briefings work better than responding to press queries.
7. The advisability of the decision to begin immunization on the strength of the Fort Dix episode is worthy of serious question and debate (see text).
8. The risk of potentially unnecessary costs in a mass vaccination campaign is minimal. (The direct cost of the 1976 program was $137 million. In today's dollars, this is <$500 million.) The potential cost of a pandemic is inestimable but astronomical.
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Lessons from 1976 flu “debacle”
"Warren Ward, 48, was in high school when the swine-flu threat of 1976 swept the United States. The Whittier, Calif., man remembers the episode vividly because a relative had died in the 1918 flu pandemic and the ’76 illness was feared to be a direct descendant of that deadly virus.
“The government wanted everyone to get vaccinated,” Ward recalled. “But the epidemic never really broke out. It was a threat that never materialized.”
What did materialize were cases of a rare side effect believed to be linked to the shot. The unexpected development cut short the vaccination effort — an unprecedented national campaign — after only 10 weeks. The episode triggered an enduring public backlash against flu vaccinations, embarrassed the federal government and cost the director of the U.S. Center for Disease Control, now known as the Centers for Disease Control and Prevention (CDC), his job.
The swine-flu brush of 1976 — some call it a “debacle” — holds critical lessons for the government and health officials who must decide how to react to the new swine-flu threat in the days and weeks ahead."
Basically the same as he LA Times article
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How to Deal with Swine Flu: Heeding the Mistakes of 1976
"In February 1976, an outbreak of swine flu struck Fort Dix Army base in New Jersey, killing a 19-year-old private and infecting hundreds of soldiers. Concerned that the U.S. was on the verge of a devastating epidemic, President Gerald Ford ordered a nationwide vaccination program at a cost of $135 million (some $500 million in today's money). Within weeks, reports surfaced of people developing Guillain-Barré syndrome, a paralyzing nerve disease that can be caused by the vaccine. By April, more than 30 people had died of the condition. Facing protests, federal officials abruptly canceled the program on Dec. 16. The epidemic failed to materialize.
Howard Markel, director of the Center for the History of Medicine at the University of Michigan and a historical consultant to the CDC on flu pandemics, says the most vexing decision facing health officials is when to institute mass vaccination programs. Vaccines carry risks of complications, leading to agonizing ethical dilemmas. In 1976, Ford offered indemnity to the vaccine manufacturers. But according to reports, President George W. Bush decided in 2002 not to administer a nationwide smallpox vaccination program — despite Vice President Dick Cheney's belief that doing so was a prudent counterterrorism step — because it could have resulted in dozens of deaths (the smallpox vaccine kills between 1 and 2 people per million people inoculated)".
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Swine flu ‘debacle’ of 1976 is recalled
Officials should be prepared for plenty of second-guessing, especially for any decisions regarding vaccination, which was at the core of the 1976 controversy, said Dr. David J. Sencer, the CDC director who led the government’s response to the threat and was later fired.
“There were good things and bad things about it,” said Sencer, who is retired and lives in the Atlanta area. “People have to make science the priority. They have to rely on science rather than politics.”
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Swine Flu Fears of 1976 Offer Lessons, and Concerns, Today
With fears of swine flu engulfing the nation in 1976, Janet Kinney got vaccinated to make sure she would be able to take care of her children. Instead, her children ended up taking care of her.
About a week after getting the swine flu shot, she recalled, “I was so weak I couldn't push down the toaster button.” She spent a month in the hospital, paralyzed from the neck down, before gradually recovering.
With health authorities now gearing up for what could be a huge vaccination campaign against a new strain of swine flu, the experience of 1976 is raising a note of caution.
The feared swine flu epidemic of 1976 never materialized. And several hundred people, including Ms. Kinney, who is now 68 and lives in Gig Harbor, Wash., developed Guillain-Barre syndrome, a rare neurological condition that causes temporary muscle weakness or paralysis. More than 30 of those people died.
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Stratfor expressed interest in the 1976 flu shot debacle
Statfor had an interest in this, why is unclear and more than a little scary.
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In the late winter of 1976, a completely novel strain of influenza was causing hundreds of respiratory infections at Fort Dix, an army post located in central New Jersey. Initially, this virus appeared to be closely genetically related to the 1918 flu pandemic that killed over a 100 million people globally, a pandemic that shared the very same Fort Dix as one its points of origin. These striking coincidences, along with the virus’s “sustained person-to-person spread,” prompted global public health officials to start planning for what could conceivably burgeon into a series of large and deadly outbreaks, if not an actual pandemic, in the upcoming winter (1).
But while the World Health Organization adopted a cautious “wait and see” policy to monitor the virus’s pattern of disease and to track the number of emerging infections, President Gerald Ford’s administration embarked on a zealous campaign to vaccinate every American with brisk efficiency. In late March, President Ford announced in a press conference the government’s plan to vaccinate “every man, woman, and child in the United States.” (1) Emergency legislation for the “National Swine Flu Immunization Program” was signed shortly thereafter on April 15th, 1976 and six months later high profile photos of celebrities and political figures receiving the flu jab appeared in the media. Even President Ford himself was photographed in his office receiving his shot from the White House doctor.
“Get a shot of protection. The swine flu shot.” The video above shows the Ford Administration’s advertisements for vaccinating agianst the swine flu.
Within 10 months, nearly 25% of the US population, or 45 million citizens, was vaccinated, but serious problems persisted throughout the process (2). Due to the urgency of creating new immunizations for a novel virus, the government used an attenuated “live virus” for the vaccine instead of a inactivated or “killed” form, increasing the probability of adverse side effects among susceptible groups of people receiving the vaccination. Furthermore, prominent American scientists and health professionals began questioning the campaign’s large expense and its drain on scarce public health resources (2).
With President Ford’s reelection campaign looming on the horizon, the campaign increasingly appeared politically motivated. The rationale for mass vaccination seemed to stem from only the barest of biological reasoning – it turned out that the flu wasn’t even related to the virus that caused the grisly 1918 epidemic and, indeed, those who were infected with the flu only suffered from a mild illness while the vaccine, for the reasons stated above, resulted in over four-hundred and fifty people developing the paralyzing Guillain-Barré syndrome. Meanwhile, outside the United States’ borders, the flu never mushroomed into the anticipated public health disaster. It was the pandemic that never was. The New York Times went so far as to dub the whole affair a “fiasco,” damning one of the largest and probably one of the most well-intentioned public health initiatives by the US government (1).
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The Long Shadow of the 1976 Swine Flu Vaccine ‘Fiasco’
On February 4 1976, a young soldier named David Lewis died of a new form of flu. In the middle of the month, F. David Matthews, the U.S. secretary of health, education and welfare, announced that an epidemic of the flu that killed Pvt. Lewis was due in the fall. “The indication is that we will see a return of the 1918 flu virus that is the most virulent form of flu,” he said, reports Patrick di Justo for Salon. He went on: the 1918 outbreak of “Spanish flu” killed half a million Americans, and the upcoming apocalypse was expected to kill a million.
Spanish influenza was another form of swine flu, di Justo writes, and researchers at the Centers for Disease Control thought that what was happening could well be a new, even deadlier strain that was genetically close to the 1918 strain.
To avoid an epidemic, the CDC believed, at least 80 percent of the United States population would need to be vaccinated. When they asked Congress for the money to do it, politicians jumped on the potential good press of saving their constituents from the plague, di Justo writes.
The World Health Organization adopted more of a wait-and-see attitude to the virus, writes Kreston. They eventually found that the strain of flu that year was not a repeat or escalation of the 1918 flu, but “the U.S. government was unstoppable,” di Justo writes. They had promised a vaccine, so there needed to be a vaccine.
This all happened in the spring, with emergency legislation for the “National Swine Flu Immunization Program,” being signed into effect in mid-April. By the time immunizations began on Oct. 1, though, the proposed epidemic had failed to emerge (although Legionnaires' Disease had, confusing matters further.)
“With President Ford’s reelection campaign looming on the horizon, the campaign increasingly appeared politically motivated,” Kreston writes. In the end, one journalist at The New York Times went so far as to call the whole thing a “fiasco.” Epidemiology takes time, politics is often about looking like you’re doing something and logistics between branches of government are extremely complicated. These factors all contributed to the pandemic that never was.
The real victims of this pandemic were likely the 450-odd people who came down with Guillain-Barre syndrome, a rare neurological disorder, after getting the 1976 flu shot. On its website, the CDC notes that people who got the vaccination did have an increased risk of “approximately one additional case of GBS for every 100,000 people who got the swine flu vaccine.”
Several theories as to why this happened exist, they say, “but the exact reason for this link remains unknown.” As for the flu shot today, the CDC writes, if there is any increased risk it is “very small, about one in a million. Studies suggest that it is more likely that a person will get GBS after getting the flu than after vaccination.”
Some, but not all, of the hesitance to embrace vaccines can be traced back to this event more than 40 years ago.
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